+ All Categories
Home > Documents > FIRST NATION MENTAL HEALTH · arousal through withdrawal, anger, addiction, self-harm and...

FIRST NATION MENTAL HEALTH · arousal through withdrawal, anger, addiction, self-harm and...

Date post: 29-Aug-2020
Category:
Upload: others
View: 1 times
Download: 0 times
Share this document with a friend
39
FIRST NATION MENTAL HEALTH: A Curriculum on Mental Wellness & Mental Illness 2013
Transcript
Page 1: FIRST NATION MENTAL HEALTH · arousal through withdrawal, anger, addiction, self-harm and suicidality, depression and anxiety, to name a few responses. It is not uncommon for First

FIRST NATION MENTAL HEALTH:

A Curriculum on

Mental Wellness & Mental Illness

2013

Page 2: FIRST NATION MENTAL HEALTH · arousal through withdrawal, anger, addiction, self-harm and suicidality, depression and anxiety, to name a few responses. It is not uncommon for First

Page 1 of 38

Inspired by the expressed wishes of Yukon First Nations’ health and social

departments this curriculum was developed under the direction of the Council of

Yukon First Nations in partnership with Mental Health Services, Yukon Government.

Funding was provided by Health Canada’s Health Services Integration Fund. This

curriculum was prepared by Leslie Knight, MSW, Whitehorse, Yukon. It was created

over a 6 month period in collaboration with Health and Social Programs staff from 5

Yukon First Nations:

Carcross Tagish First Nation

Champagne Aishihik First Nation

First Nation of Na-cho Nyak Dun

Tr’ondëk Hwëch’in First Nation

Little Salmon Carmacks First Nation

Page 3: FIRST NATION MENTAL HEALTH · arousal through withdrawal, anger, addiction, self-harm and suicidality, depression and anxiety, to name a few responses. It is not uncommon for First

Page 2 of 38

CONTENTS Introduction ................................................................................................................................................................... 3

Mental Wellness ............................................................................................................................................................ 5

Principles of Mental Wellness ................................................................................................................................... 5

Determinants of Health (tab 1) ................................................................................................................................. 6

Physiological And Safety Needs ............................................................................................................................ 7

Supportive Responses ........................................................................................................................................... 7

Cultural Safety ....................................................................................................................................................... 8

Brain Care (tab 2) ...................................................................................................................................................... 9

Nutrition ................................................................................................................................................................ 9

Flourish (tab 3) ........................................................................................................................................................ 12

Positivity .............................................................................................................................................................. 13

Engagement ........................................................................................................................................................ 16

Relationships ....................................................................................................................................................... 17

Meaning .............................................................................................................................................................. 20

Accomplishment ................................................................................................................................................. 21

A Holistic Approach to Wellness ............................................................................................................................. 22

Mental Illness .............................................................................................................................................................. 25

Challenges to Mental Health (tab 4) ....................................................................................................................... 26

Seasonal Affective Disorder (S.A.D.) ................................................................................................................... 26

Grief .................................................................................................................................................................... 26

Diagnostic Statistical Manual .................................................................................................................................. 27

Symptoms, Duration, and Presentation .............................................................................................................. 27

Clinical Disorders ..................................................................................................................................................... 28

Addiction and Mental Illness (tab 5) ................................................................................................................... 28

Depression (tab 6)............................................................................................................................................... 30

Anxiety (tab 7) .................................................................................................................................................... 31

Psychosis (tab 8) ................................................................................................................................................. 32

Personality Disorders .............................................................................................................................................. 33

Dependent Personality Traits & Disorder ........................................................................................................... 33

Borderline Personality Traits/Disorder ............................................................................................................... 34

Narcissistic Personality Traits/Disorder .............................................................................................................. 35

Summary ...................................................................................................................................................................... 36

bibliography ................................................................................................................................................................. 37

Page 4: FIRST NATION MENTAL HEALTH · arousal through withdrawal, anger, addiction, self-harm and suicidality, depression and anxiety, to name a few responses. It is not uncommon for First

Page 3 of 38

INTRODUCTION

This curriculum on mental health is divided into two parts: mental wellness, and mental illness. Mental wellness

can both prevent mental illness and be nurtured when a mental illness is present.

Mental Wellness includes:

Determinants of Health Physiological and safety needs

Supportive responses

Cultural safety

Brain Care Nutrition Exercise

Flourish Positivity Engagement Relationships Meaning Accomplishment

A Balanced Approach to Wellness

Mental Illness includes:

Problems & Illnesses (including but not limited to):

Challenges to Mental Health Seasonal Affective Disorder

Grief

Clinical Disorders Addiction and Mental Illness

Depression

Anxiety

Psychosis

Personality Disorders Dependent Personality Traits/ Disorder

Borderline Personality Traits/ Disorder

Narcissism Personality Traits/ Disorder

What is Mental Health?

“Mental health is defined as a state of well-being

in which every individual realizes his or her own

[abilities], can cope with the normal stresses of

life, can work productively and fruitfully, and is

able to make a contribution to her or his

community.”

“The positive dimension of mental health is

stressed in the World Health Organization’s

definition of health as contained in its

constitution: "Health is a state of complete

physical, mental and social well-being and not

merely the absence of disease or infirmity."

World Health Organization

Page 5: FIRST NATION MENTAL HEALTH · arousal through withdrawal, anger, addiction, self-harm and suicidality, depression and anxiety, to name a few responses. It is not uncommon for First

Page 4 of 38

MENTAL WELLNESS

Page 6: FIRST NATION MENTAL HEALTH · arousal through withdrawal, anger, addiction, self-harm and suicidality, depression and anxiety, to name a few responses. It is not uncommon for First

Page 5 of 38

MENTAL WELLNESS

PRINCIPLES OF MENTAL WELLNESS

Determinants of Health Physiological and safety needs

Supportive responses

Cultural Safety

Brain Care Nutrition

Exercise

Flourish

Positivity

An optimal balance of positivity and negativity:

3:1 ratio

Generosity

Gratitude

Forgiveness

Engagement

Being ‘in the flow’ and time seems to stop

Relationships

Safe and supportive

Conflict resolution

Trust and Betrayal

Meaning

Using our strengths to engage in something beyond ourselves

Pursued for its own sake and independent from positivity, engagement, relationships, and achievement

though these may be present

Accomplishment

Success for its own sake, not for monetary gain or approval

Not for pleasure, engagement or meaning, though these may be present

A Balanced Approach to Wellness Balance in all areas of our lives through the Medicine Wheel and A

Another Definition of Mental Health

“Mental health is the capacity to feel, think

and act in ways that enhance one’s ability to

enjoy life and deal with challenges.

Expressed differently, mental health refers

to various capacities including the ability to

understand oneself and one’s life, relate to

other people and respond to one’s

environment, experience pleasure and

enjoyment, handle stress and withstand

discomfort, evaluate challenges and

problems, pursue goals and interests and

explore choice and make decisions”.

Kirby and Leon, Canadian Mental Health Commission

Page 7: FIRST NATION MENTAL HEALTH · arousal through withdrawal, anger, addiction, self-harm and suicidality, depression and anxiety, to name a few responses. It is not uncommon for First

Page 6 of 38

DETERMINANTS OF HEALTH Our health, including our mental health, is determined in

three primary ways, through the:

Social and economic environment

Physical environment

Person’s individual characteristics and behaviours

(Health Impact Assessment: The Determinants of Health)

According to Abraham Maslow in 1943, and social scientists since then, our needs are hierarchical with basic physiological and safety needs forming the base from which ‘higher’ needs may be addressed.

Maslow’s Hierarchy of Needs

Social Determinants of Health

1. Income & Income Distribution

2. Education

3. Unemployment & Job Security

4. Employment & Working Conditions

5. Early Childhood Development

6. Food Insecurity

7. Housing

8. Social Exclusion

9. Social Safety Network

10. Health Services

11. Aboriginal Status

12. Gender

13. Race

14. Disability

Mokkonen and Raphael, Social Determinants of

Health: The Canadian Facts

Page 8: FIRST NATION MENTAL HEALTH · arousal through withdrawal, anger, addiction, self-harm and suicidality, depression and anxiety, to name a few responses. It is not uncommon for First

Page 7 of 38

PHYSIOLOGICAL AND SAFETY NEEDS Healthy environments that meet our basic needs are the

foundation of mental health. Being safe is an important part of

wellness; without it; our capacity to turn our attention to

nutrition, exercise, and flourishing is compromised.

These challenges to mental wellness are appreciated within the

context of violence and other forms of oppression, internalized

and learned racism, abuse, addictions and mental illness, and

healing.

SUPPORTIVE RESPONSES Positive and supportive social response to critical incident, and

violence and other forms of oppression, provide safety and

security. When high levels of emotional and mental arousal

(meant to mobilize us to protect ourselves and our loved ones)

are quickly decreased within a safe environment, the likelihood

of the development of post trauma stress and mental illnesses is

greatly decreased. (Brymer, Psychological First Aid: Field

Operations Guide 2nd

Edition).

Alternatively, when the psychosocial response to critical incidents and violence is negative or not available, people

remain in high states of emotional and mental arousal in as they attempt to create safety for themselves and their

loved ones. When unsafe conditions persist for years there are inevitable attempts to manage high levels of

arousal through withdrawal, anger, addiction, self-harm and suicidality, depression and anxiety, to name a few

responses.

It is not uncommon for First Nation men and women, elders and youth, to experience challenges to their mental

health resulting from the negative social responses to their experiences of residential school, colonialization,

violence, and trauma.

WHAT TO DO?

Provide supportive responses to past and present trauma and

violence, including the following core actions of psychosocial first aid:

o Contact and engagement

o Safety and comfort

o Stabilization

o Ask what they need

o Provide what is needed

o Connect with more social supports

o Discuss ways to stay safe, be supported & to cope

o Link with supportive, collaborative services

No Blame/ No Shame

“The context of people’s lives

determine their health, and so blaming

individuals for having poor health or

crediting them for good health is

inappropriate. Individuals are unlikely

to be able to directly control many of

the determinants of health. These

determinants – or things that make

people health or not – include the

above and many factors, and many

others.”

Mokkonen and Raphael, Social Determinants of Health: The Canadian Facts

Supportive Responses

“Supportive responses recognize

and honour the ways people resist

violence and other forms of

oppression, rather than

pathologizing them; and in doing

so address a wide variety issues

related to health lifestyles and

mental wellness.”

Richardson and Wade, Talking

Resistance Seriously

Page 9: FIRST NATION MENTAL HEALTH · arousal through withdrawal, anger, addiction, self-harm and suicidality, depression and anxiety, to name a few responses. It is not uncommon for First

Page 8 of 38

CULTURAL SAFETY The concept of cultural awareness relates to all workers

of all backgrounds to be aware of their cultural values,

social norms, use of power, and perspectives. One’s

ability to relate to others is greatly enhanced through

cultural self-awareness. Trust and engagement has a

positive effect on people accessing mental health

services and participating in healthy wellness activities.

In Canada, according to the Canadian Association of

Nurses, “all registered nurses who graduate from nursing

programs in Canada should understand the relationships

between First Nations, Inuit, and Métis Peoples and the

Government of Canada” in order to “comprehend the

historical and contemporary contexts of Aboriginal

Peoples”. (Canadian Nurses' Association)

The goals of cultural safety are to engage in an on-going

process that involves:

Cultural self-reflection through engagement and

self-reflection

Understanding the relationships between First

Nations and the Government of Canada

Analysis of power imbalances and our use of

power

WHAT TO DO?

Take stock of your own traditions learned from childhood and in your adult life:

o Remember your childhood routines and what you learned about people and life.

o What messages have you internalized?

Notice your automatic thoughts and behaviours:

o How do you use your personal and professional influence and power?

o What judgments come readily and unbidden to your mind about yourself; about other people?

Seek supervision and consultation

“Cultural Safety is a concept

developed in New Zealand by nurses

working with Mãori that moves beyond the

traditional concept of cultural sensitivity

(being accepting to difference) to analysing

power imbalances, institutional

discrimination, colonisation and

relationships with colonisers. It develops the

idea that to provide quality care for people

from different ethnicities than the

mainstream, health care providers must

embrace the skill of self-reflection as a

means to advancing a therapeutic encounter

and provide care congruent with the

knowledge that cultural values and norms of

the patient are different from his/her own”.

www.en.wikipedia.org/wiki/Cultural_safety

Page 10: FIRST NATION MENTAL HEALTH · arousal through withdrawal, anger, addiction, self-harm and suicidality, depression and anxiety, to name a few responses. It is not uncommon for First

Page 9 of 38

BRAIN CARE

“Can everyday acts and lifestyle factors play a role in treating or managing mental health problems, like anxiety

and depression? This is an important question because every year about 1 in 5 Canadians will be diagnosed with a

mental health problem; and twice that number, or about 40 percent of us, will experience a mental health

problem sometime in our life. It turns out that the answer to the question is yes, lifestyle changes can help treat or

manage a mental health problem”. www.yukonwellness.ca

Lifestyle changes to consider for mental wellness include nutrition and exercise:

Nutrition

A Healthy Diet

Water

Omega 3

Vitamin D3

Exercise

NUTRITION

A HEALTHY DIET

Eating well helps us to prevent diseases related to vitamin

and mineral deficiencies, such as: insufficient absorption;

dehydration; too much of some foods (sugar, saturated

fats, and caffeine) and our inability to process some foods.

Eating well also helps our mental health; we feel

emotionally well.

For reasons we do not always know, people with mental

health problems are more likely to have a weight problem.

This may be related to the mental health problem itself or

related to the treatment. This doesn’t mean we need to

stop medication but it may require a conversation with

your medical caregiver about changing medications, eating

differently, and/or becoming more active.

WATER

Dehydration (water deficiency in our body) can lead to

tiredness, dry skin, headaches and even depression. We

need water: most of our body is water!

It is suggested that we need to drink about 8 glasses a day or about 2 litres, but this depends on your level of

activity, weight and other things.

If you can’t stand plain water, there is still hope. You can drink juices and teas instead. Eating lots of fruit also helps

a lot. Even coffee has an ultimately hydrating quality but not as much as non-caffeinated drinks.

Weight & Mental Health http://www.rcpsych.ac.uk/expertadvice/problems/eatingwellandmentalhealth.aspx

Water & Mental Health http://getoutofdepression.wordpress.com/2013/01/31/water-is-your-friend/

Page 11: FIRST NATION MENTAL HEALTH · arousal through withdrawal, anger, addiction, self-harm and suicidality, depression and anxiety, to name a few responses. It is not uncommon for First

Page 10 of 38

OMEGA 3

Omega 3 plays an important role in the brain. Omega 3 can be

found in:

Salmon, halibut & tuna

Flaxseeds, walnuts & olive oil

Beans

Leafy green vegetables

Winter squash

Omega 3 fats should be 2% of our daily caloric intake. They are

damaged by heat so oils should not be cooked. We need diets that

include both Omega 3 and Omega 6. Most diets include enough

Omega 6 so supplementation of Omega 6 is usually not necessary.

VITAMIN D3

The sunshine vitamin (Vitamin D3) is important for our

general health. Several studies have linked adequate

Vitamin D3 to healthy brain functioning & mental health.

Humans receive Vitamin D3 from:

Sun exposure

Food

Supplements

The amount of Vitamin D3 we need in our diet varies

according to our age and exposure to sun (see the Eat Right

Ontario reference to the left). We need about 10 – 15

minutes of sun exposure at least twice a week on the face

arms, hands or back without sunscreen with a greater than

3 UV index for adequate amounts of Vitamin D3. In the

north it is difficult to have adequate sun exposure during

the winter months. There are therapeutic lights on the

market to use indoors to simulate the sun.

Foods with Vitamin D3 include:

Cod liver oil

Salmon & tuna

Fortified milk, orange juice, yogurt and margarine

Supplements can be found in grocery & health food stores.

S

Vitamin D3 & Mental Health

http://www.psychologytoday.com/blog/the-breakthrough-depression-solution/201111/psychological-consequences-vitamin-d-deficiency http://www.cmaj.ca/content/182/17/1886.2.full http://www.eatrightontario.ca/en/Articles/Nutrients-(vitamins-and-minerals)/What-you-need-to-know-about-Vitamin-D.aspx http://www.msoe.edu/life_at_msoe/current_student_resources/student_resources/counseling_services/newsletters_for_mental_health/combating_the_winter_blues.shtml

Omega 3 & Mental Health http://getoutofdepression.wordpress.com/tag/mental-health/ http://www.ncbi.nlm.nih.gov/pubmed/15907142 http://www.ncbi.nlm.nih.gov/pubme

d/20974418

Page 12: FIRST NATION MENTAL HEALTH · arousal through withdrawal, anger, addiction, self-harm and suicidality, depression and anxiety, to name a few responses. It is not uncommon for First

Page 11 of 38

The amount of vitamin D3 you need depends on your age.

Age group Aim for an intake of international units (IU)/day

Stay below IU/day*

Infants 0-6 months old 400 1000

Infants 7-12 months old 400 1500

Children 1-3 years old 600 2500

Children 4-8 years old 600 3000

Children and Adults 9-70 years old 600 4000

Adults over 71 years old 800 4000

Pregnant and Breastfeeding Women 600 4000

*This includes vitamin D from both food and supplements

Eat Right Ontario

Exercise

Exercise improves mental health by reducing anxiety,

depression, and negative mood and by improving self-

esteem and cognitive function. Exercise has also been found

to alleviate symptoms such as low self-esteem and social

withdrawal. (Sharma et al, Exercise for Mental Health)

Exercise can accomplish as much or more than an hour of

counselling per week and much more than another cup of

coffee.

Exercise:

Regulates weight

Builds physical strength

AND

Improves sleep

Improves self esteem

Reduces stress & anxiety

Calms the nerves

Improves mood

Enhances vitality

What is the optimal amount of physical activity for better mental health?

2.5 – 7.5 hours of exercise per week depending on your gender, age, and general physical health

Mental health may begin to decline with over 7.5 hours of exercise per week

Exercise & Mental Health http://www.ncbi.nlm.nih.gov/pmc/arti

cles/PMC1470658/

Page 13: FIRST NATION MENTAL HEALTH · arousal through withdrawal, anger, addiction, self-harm and suicidality, depression and anxiety, to name a few responses. It is not uncommon for First

Page 12 of 38

FLOURISH From Martin Seligman’s book, Flourish, we learn that

flourishing in life is more than just a subjective sense

of happiness; it is much more than that.

Seligman identified 5 ways to flourish:

Positivity

Engagement

Relationships

Meaning

Accomplishment

Each of these measures studied by researchers and

found in positive psychology stand alone and is not

dependent on any other one. For example, while the

experience of positivity is subjective, none of the

others rely on a subjective experience of ‘feeling’

happy. And the experience of meaning does not rely

on accomplishing anything. And being engaged does not necessarily have to do with relationships or meaning.

Happiness is different from flourishing. We can flourish and not be happy. We can flourish and still experience

anxiety. We can flourish and have a mental disorder.

Flourishing Mental Wellness: Flourishing brochure What makes you happy? youtube video http://www.youtube.com/watch?v=As-

g_dwgJig

***

Information sheet: Mental Wellness: Flourish

Page 14: FIRST NATION MENTAL HEALTH · arousal through withdrawal, anger, addiction, self-harm and suicidality, depression and anxiety, to name a few responses. It is not uncommon for First

Page 13 of 38

POSITIVITY

Positive thoughts and emotions are the first element of mental wellness. They used to be our only measure of

happiness and well-being but now, according to Martin Seligman and other social scientists, how we feel is only

one of the elements.

Barbara Fredrickson (Positivity) studies and writes

about paying attention to the positives in our daily life.

Paying attention to the negatives in our life leads to

negativity. Not enough positivity leads to feeling

negative about life and to behaving in unhealthy ways.

Our positive and negative thoughts and emotions play

an important role in our mental health. Positivity is not

about ‘creating’ positives. Rather, positivity is about

noticing the positive aspects already taking place in our

lives. (Frederickson, Positivity)

There is a scientifically discovered tipping point

between positivity and negativity. Dr. Barbara

Fredrickson has discovered the optimal balance is 3:1;

three positives to every negative.

Negativity is not bad. We may need to pay attention to

what is negative around us for our emotional and physical survival. Alternatively, acceptance may be required as

the wise sage wrote in the Serenity Prayer.

Positivity activities:

Start a positivity journal. Throughout the day, or before you go to bed at night, write down your deeply felt

positive responses to events and observations of your day.

Register and complete the Positivity Ratio questionnaire as often as you want at:

http://www.positivityratio.com/index.php

Positivity

http://www.yukonwellness.ca/3to1.php

http://www.positivityratio.com/single.php

http://www.positivityratio.com/index.php

***

Information sheet: Mental Wellness: Positivity

Serenity Prayer

Grant me the serenity to accept the things I cannot change; the courage to change the things I can; and

the wisdom to know the difference.

Adapted from the prayer by Reinhold Niebuhr

Page 15: FIRST NATION MENTAL HEALTH · arousal through withdrawal, anger, addiction, self-harm and suicidality, depression and anxiety, to name a few responses. It is not uncommon for First

Page 14 of 38

Gratitude

Gratitude is the personal experience of appreciation that leads to positivity. “Gratitude is many things to many

people. It is wonder; it is appreciation; it is looking on the bright side of a setback; it is fathoming abundance; it is

thanking someone in your life; it is thanking God; it is ‘counting blessings.’ It is savoring; it is not taking things for

granted; it is coping; it is present-oriented.” From The How of Happiness: A new approach to getting the life you

want by Sonja Lyubomirsky.

Gratitude activity:

Think of someone you appreciate. This person may be in your life now or someone who influenced you from the

past. Sit down and write a letter of gratitude. If the person is still alive, consider sending the letter to them. How

did you feel as you wrote the letter?

Generosity

By putting our time and energy into our relationships we can change ourselves in a positive direction. When we

share what we have with others, we experience being connected. As a human animal we rely on our ‘pack’ ; other

people are the best corrective when we are down and where we go to share our ‘ups’.

It has been said, if you are down and discouraged, do something for someone. The act of giving changes our

thinking (we become more positive) and changes our emotions (we feel happier).

“Helping others, volunteering, and working in groups are associated with an increased sense of self-worth and

positive feelings like happiness and life satisfaction. It turns out that giving has a greater impact on well-being than

receiving. Contributing to one’s community creates a sense of belonging and connectedness to others, and it

creates a stronger, more supportive and more inclusive community. When reciprocity – the act of giving and

receiving – becomes the community norm, we all benefit”. www.yukonwellness.ca

Generating generosity:

Take stock of your skills; what can you offer to an individual, an organization, or your community?

Make an offering to help or volunteer.

Once arranged, follow through even if you don’t feel like it.

Forgiveness

“Nearly everyone has been hurt by the actions or words of another. Perhaps your mother criticized your parenting

skills, your colleague sabotaged a project or your partner had an affair. These wounds can leave you with lasting

feelings of anger, bitterness or even vengeance — but if you don't practice forgiveness, you might be the one who

pays most dearly. By embracing forgiveness, you can also embrace peace, hope, gratitude and joy. Consider how

forgiveness can lead you down the path of physical, emotional and spiritual well-being.

Generally, forgiveness is a decision to let go of resentment and thoughts of revenge. The act that hurt or offended

you might always remain a part of your life, but forgiveness can lessen its grip on you and help you focus on other,

positive parts of your life. Forgiveness can even lead to feelings of understanding, empathy and compassion for the

one who hurt you.

Page 16: FIRST NATION MENTAL HEALTH · arousal through withdrawal, anger, addiction, self-harm and suicidality, depression and anxiety, to name a few responses. It is not uncommon for First

Page 15 of 38

Forgiveness doesn't mean that you deny the other person's responsibility for hurting you, and it doesn't minimize

or justify the wrong. You can forgive the person without excusing the act. Forgiveness brings a kind of peace that

helps you go on with life”. (Mayo Clinic)

Here are some benefits of letting go of grudges and bitterness:

Healthier relationships

Greater spiritual and psychological well-being

Less anxiety, stress and hostility

Lower blood pressure

Fewer symptoms of depression

Lower risk of alcohol and substance abuse

Forgiveness activity:

Notice your negativity about a person who has done something you that have taken personally, whether or

not it was intentional; large or small.

Speak with a trusted friend or counsellor about your resentment, blame, sense of betrayal or whatever

arises.

Consider the value of forgiveness and its importance in your life

Reflect on that person’s behaviour and consider how they, too, may be suffering.

When you are ready, actively choose to forgive.

Consider a letting go ceremony alone or with another person or a group

Another technique that brings you in touch with your own compassion, instead of bitterness, is to breathe

in the suffering of the other person and breathe out love and compassion.

Enjoy the sensation of no longer being a victim.

Page 17: FIRST NATION MENTAL HEALTH · arousal through withdrawal, anger, addiction, self-harm and suicidality, depression and anxiety, to name a few responses. It is not uncommon for First

Page 16 of 38

ENGAGEMENT Engagement is about intense concentration,

being ‘in the flow’ and fully engaged. Time

seems to stop. Research tells us that being

‘in the flow’ is a key component of

flourishing.

Engagement is when we become totally

committed and fully involved.

We know when we’ve been ‘engaged’ and

‘in-the’flow’ when we look back and realize

we were lost in the activity and not aware

that time was passing.

Pleasures in the moment may lead to

positivity. Engagement, however, has longer,

lasting effects than mere pleasures.

To listen to Mihaly Csikszentmihalyi speak about the effortless and spontaneous flow of experience Watch the Ted

Talk: http://www.ted.com/talks/mihaly_csikszentmihalyi_on_flow.html

(Mihaly Csikszentmihalyi: Flow: the secret of happiness)

Engagement activities:

Learn new things

Pursue creativity

Ponder the world

Appreciate nature

Become absorbed in something you love

Know and use your strengths to engage

Engagement

http://www.ted.com/talks/mihaly_csikszentmihalyi_on_fl

ow.html

http://psychology.about.com/od/PositivePsychology/a/fl

ow.htm

***

Information sheet: Mental Wellness: Engagement

Page 18: FIRST NATION MENTAL HEALTH · arousal through withdrawal, anger, addiction, self-harm and suicidality, depression and anxiety, to name a few responses. It is not uncommon for First

Page 17 of 38

RELATIONSHIPS As with positivity, relationships benefit from regular acts and

expressions of gratitude, generosity, and forgiveness.

Safe and loving relationships are respectful and both parties

contribute to the long-term success of relationships.

CONFLICT RESOLUTION

Conflict is a normal part of any health relationship. After all,

two people can’t expect to agree on everything, all the time.

Where does conflict come from?

Conflicts arise from differing needs. Everyone wants to feel

understood and supported. And we all have different ways to

feel comfortable and safe. And these differing needs create

our biggest challenges.

A conflict is more than a disagreement; there is always a

perception of threat to our safety or to our emotional

wellbeing. And conflicts get worse if they are ignored. And

conflicts trigger some of our strongest emotions.

The way to resolving conflicts is to build skills that turn conflicts into opportunities, such as:

1. NOT TAKING IT PERSONALLY: This is the most valuable skill when someone is reactive and blaming and

angry toward you - even when they seem to be pointing at you. They are distressed and frustrated and

need your kindness. We seem to be hard-wired with the habit of taking things personally, even when it is

the other person who is reacting. Sure, they may be pointing fingers and blaming us for something that

frustrates them…however, their reaction and their frustration belongs to them. It is not about us.

2. MANAG ING YOUR OWN STRESS LEVEL: When you are emotional, stressed, and reactive the next most

important skill is to manage your own stress level by remembering you can take time to look at what is

going on for you. Coming to our senses’ takes on new meaning when we apply it to calming ourselves

through our senses of seeing, hearing, touching, tasting and smelling. Notice what soothes you.

3. REALLY LISTENING: The third most valuable skill is to listen – truly listen. Listening is about paying

attention to the feelings another person is expressing, even if your own emotions are strong. Stay aware

of and be respectful of differences.

4. USING HUMOUR: And the fourth skill is humour. At the right moment, without offending anyone, play

and humour can allow things to be said easily without intense emotion and stress.

Conflict often feels more threatening than it really is, because we bring to the conflict so much experience – such

as past traumas, shame, hurt, cultural abuse, and more from our early life experiences when we felt powerless. So,

first we need to reduce our stress while remaining calm and aware of what is going on. Control your emotions can

be easier said than done, but tolerating distress means to have methods of calming ourselves and not expecting

anyone else to do it for us.

Relationships

http://psychcentral.com/blog/archives/2012/

08/09/the-relationship-between-happiness-

and-gratitude/

http://www.helpguide.org/mental/eq8_confli

ct_resolution.htm

http://www.yukonwellness.ca/relationships.p

hp#.UTuaI9aR-E4

***

Information sheet: Mental Wellness: Relationships

Page 19: FIRST NATION MENTAL HEALTH · arousal through withdrawal, anger, addiction, self-harm and suicidality, depression and anxiety, to name a few responses. It is not uncommon for First

Page 18 of 38

Healthy and unhealthy ways of managing and resolving conflict

Unhealthy responses to conflict: Healthy responses to conflict

An inability to recognize and respond to the

things that matter to the other person

The capacity to recognize and respond to the things

that matter to the other person

Explosive, angry, hurtful, and resentful reactions Calm, non-defensive, and respectful reactions

The withdrawal of love, resulting in rejection,

isolation, shaming, and fear of abandonment

A readiness to forgive and forget, and to move past

the conflict without holding resentments or anger

An inability to compromise or see the other

person’s side

The ability to seek compromise and avoid punishing

The fear and avoidance of conflict; the

expectation of bad outcomes

A belief that facing conflict head on is the best thing

for both sides

www.helpguide.org/mental/eq8_conflict_resolution.htm

Quick Stress Relief Stress interferes with our ability to: Notice another person’s nonverbal communication. Hear what they are really saying. Be aware of our own feelings. Know our needs Speak clearly and respectfully Relax our bodies Breathe easily Takes up a lot of our time and energy which we could be using for other things.

Managing and resolving conflict requires the ability to quickly reduce stress and bring your emotions into balance.

Being able to manage and relieve stress in the moment is the key to staying balanced, focused, and in control, no

matter what challenges you face. If you don’t know how to stay centered and in control of yourself, you will

become overwhelmed in conflict situations and unable to respond in healthy ways.

Psychologist, Connie Lillas (Conflict Resolution Skills), uses a driving analogy to describe the three most common

ways people respond when they’re overwhelmed by stress:

Foot on the gas. An angry or agitated stress response. You’re heated, keyed up, overly emotional, and unable to sit still.

Foot on the brake. A withdrawn or depressed stress response. You shut down, space out, and show very little energy or emotion.

Foot on both gas and brake. A tense and frozen stress response. You “freeze” under pressure and can’t do anything. You look paralyzed, but under the surface you’re extremely agitated.

Page 20: FIRST NATION MENTAL HEALTH · arousal through withdrawal, anger, addiction, self-harm and suicidality, depression and anxiety, to name a few responses. It is not uncommon for First

Page 19 of 38

Trust and betrayal

Issues of trust and betrayal in relationships manifest with little

notice and can endure for generations. Safe and nurturing

relationships require the ability to develop trust and to

negotiate betrayals. For aboriginal people around the world, acts

of colonialism were major betrayals, at once personal and

societal.

According to Reina and Reina (Rebuilding Trust in the

Workplace), trust cannot be assumed in a relationship; we build trust in each of our relationships reciprocally and

over time. It builds on itself as we give and receive and learn about trust with everyone with whom we have a

relationship. A sense of betrayal is inevitable at some point in every relationship. The type of the betrayal may be

small or large. Betrayal can be intentional or unintentional.

Betrayal of Trust Not Intentional Intentional

Small Small Moderate

Large Moderate Great

Each relationship has a level of capacity for trust that can be betrayed and can grow. We relate variably with

everyone and differently over time in each of relationships. Here are three ways to look at trust:

Trusting our skills

Acknowledge people’s skills and abilities

Allow people to make decisions

Involve others and seek their input

Help people learn skills

Trusting our strength of character

Manage expectations

Establish boundaries

Delegate appropriately

Encourage mutually serving intentions

Keep agreements

Be consistent

Trusting communications

Share information

Tell the truth

Admit mistakes

Give and receive constructive feedback

Maintain confidentiality

Speak with good purpose

Adapted from: Reina and Reina, Rebuilding Trust in the Workplace

TRUST & BETRAYAL

http://www.reinatrustbuilding.com

Page 21: FIRST NATION MENTAL HEALTH · arousal through withdrawal, anger, addiction, self-harm and suicidality, depression and anxiety, to name a few responses. It is not uncommon for First

Page 20 of 38

MEANING

According to Martin Seligman, a meaningful life is about

having a vision of what is important in life and making a

contribution to a positive human future.

Pursued for its own sake, it is independent from positivity,

engagement, relationships, and achievement though it

may contain one or more of all four aspects of flourishing

First of all, take time to clarify what is most important to

you and identify your strengths that will support you to

engage in or contribute to something we believe goes beyond self-interest.

Watch the youtube video: What makes you happy? http://www.youtube.com/watch?v=As-g_dwgJig

Meaning clarifying activities:

Take stock of your strengths and what you value the most in life.

Write down your vision of a positive human future. What would make the world a better place?

Write down what you would like your grandchildren to say about what you did in life to contribute to a

positive human future.

Meaning What makes you happy? youtube video http://www.youtube.com/watch?v=As-

g_dwgJig

Page 22: FIRST NATION MENTAL HEALTH · arousal through withdrawal, anger, addiction, self-harm and suicidality, depression and anxiety, to name a few responses. It is not uncommon for First

Page 21 of 38

ACCOMPLISHMENT The fifth and last way to flourish is accomplishment. In Seligman’s book, Flourish, the concept of “accomplishment’

includes more than career or material achievement; they are activities for their own sake and regardless of

income.” (Seligman, Flourish)

The accomplishment being spoken of here is not for

pleasure, engagement or meaning, though these may also

be present.

Regardless of outcome, the activities pursued for

accomplishment are enjoyable and satisfying.

WHAT ARE THESE ACTIVITIES?

‘Accomplishing’ activities are different from one person to

the next, and you may pursue the activity with others.

Accomplishment activities:

Take two minutes to write down what you find most enjoyable and satisfying in life.

Next, priorize their importance in your life with 1. Being the most important and so on: 2. 3. …

Reflect on how these can be incorporated into your daily life.

Plan to do the things that are meaningful to you.

Accomplishment http://umbrellahealth.wordpress.com/?s=accomplishment&submit=Search

Page 23: FIRST NATION MENTAL HEALTH · arousal through withdrawal, anger, addiction, self-harm and suicidality, depression and anxiety, to name a few responses. It is not uncommon for First

Page 22 of 38

A HOLISTIC APPROACH TO WELLNESS The circle, denoting the whole, can be divided in different ways. Two models of wellness are:

Wellness Medicine Wheel

A Holistic Model of Wellness

A Holistic Model of Wellness

www.yukonwellness.ca

Working with Balanced Models of Wellness

Every First Nation works with their own unique model of wellness established over generations. And there

are many ways to apply the teachings. In individual work, the person is guided to look into the ‘mirror’

and see what can be seen that would put their life back into balance after a period of grief, violence, or

poor health, including addiction and mental illness.

Page 24: FIRST NATION MENTAL HEALTH · arousal through withdrawal, anger, addiction, self-harm and suicidality, depression and anxiety, to name a few responses. It is not uncommon for First

Page 23 of 38

Wellness Medicine Wheel

A holistic approach to wellness seeks to balance of all aspects of the medicine wheel. Wholeness is achieved when

all aspects of the holistic model are in balance.

“The teachings found on the Medicine Wheel create a bio-psychosocial and spiritual foundation for human

behaviour and interaction. The medicine wheel teachings are about walking the earth in a peaceful and good way,

they assist in helping to seek; healthy minds (East), strong inner spirits (South), inner peace(West) and strong

healthy bodies (North).

A Medicine Wheel can best be described as a mirror within, which everything about the human condition is

reflected back. It requires courage to look into the mirror and really see what is being reflected back about an

individual's life. It helps us with our creative "Vision", to see exactly where we are in life and which areas we need

to work on and develop in order to realize our full potential. It is a tool to be used for the upliftment and

betterment of humankind, healing and connecting to the Infinite.” (Laframboise and Sherbina, Dancing to Eagles

Spirit Society)

Yukon First Nations’ Mental Wellness Workbook, AHTF 2010.

Page 25: FIRST NATION MENTAL HEALTH · arousal through withdrawal, anger, addiction, self-harm and suicidality, depression and anxiety, to name a few responses. It is not uncommon for First

Page 24 of 38

MENTAL ILLNESS

Page 26: FIRST NATION MENTAL HEALTH · arousal through withdrawal, anger, addiction, self-harm and suicidality, depression and anxiety, to name a few responses. It is not uncommon for First

Page 25 of 38

MENTAL ILLNESS

Mental Problems and Illnesses

(including but not limited to):

Challenges to Mental Health Seasonal Affective Disorder

Grief

Diagnostic Statistical Manual Symptoms, Duration, and Presentation

Clinical Disorders Addiction and Mental Illness

Depression

Anxiety

Psychosis

Personality Disorders Dependent Personality Traits/Disorder

Borderline Personality Traits/Disorder

Narcissistic Personality Traits/Disorder

What is Mental Illness?

“A mental illness can be defined as a health condition that changes a person’s thinking, feelings, or behavior (or all three) and that causes the person distress and difficulty in functioning. As with many diseases, mental illness is severe in some cases and mild in others.”

National Institutes of Health, USA

Page 27: FIRST NATION MENTAL HEALTH · arousal through withdrawal, anger, addiction, self-harm and suicidality, depression and anxiety, to name a few responses. It is not uncommon for First

Page 26 of 38

CHALLENGES TO MENTAL HEALTH

SEASONAL AFFECTIVE DISORDER (S.A.D.) Seasonal affective disorder (SAD) is a type of depression (see Depression for more information) that typically

occurs each year during fall and winter in the north such as the Yukon due to the lower levels of light.

Light therapy boxes can offer effective treatment for SAD. Light box therapy may be effective on its own or in

combination with medication and counselling. All light boxes for SAD

treatment are designed do the same thing, but one may work better for you

than another. Be sure to consult with your doctor so that you get a light

therapy box that best suits your needs. (Mayo Clinic)

A light box mimics outdoor light. Researchers believe this type of light causes

a chemical change in the brain that lifts your mood and eases other

symptoms of SAD. Most people use light boxes for a minimum of 30 minutes

each morning.

GRIEF The death of someone close to us is one of life’s most stressful events, particularly in small communities based on

close kinship and cultural ties. Unexpected and premature deaths are difficult; also the deaths of Elders are

difficult for it is they who carry the cultural history, traditions, and language. And “when the death is from suicide,

family and friends must cope with sadness at the loss plus all their feelings of confusion and sometimes even

anger. It takes time to heal and each of us responds differently. We may need help to cope with the changes in our

lives. But in the end, coping effectively with bereavement is vital to our mental health.” (Canadian Mental Health

Association)

Grief is a natural response to loss. It’s the emotional suffering you feel when something or someone you love is

taken away. Grief takes time to heal and each of us grieves differently. Complicating grief in Yukon, and for

aboriginal people around the world, are the tremendous cultural and family losses related to residential school and

other colonial policies; many on-going today.

A supportive community response is the single-most important aspect of healing form grief for First Nation

families and communities. Significant and elaborate systems of clanship delineate traditional roles and

responsibilities when someone dies and for a year afterward.

Important responses from caregivers encourage someone grieving to:

Seek and accept support

Take care of themselves

Accept a referral to a medical or mental health practitioner if there is one or more of the following:

o Severe and persistent sense of guilt

o Changes in sleeping and eating

o Thoughts of suicide

o Feelings of hopelessness

o Slow speech and body movements

o Inability to function at home, school, or work

www.helpguide.org/mental/grief_loss.htm

Page 28: FIRST NATION MENTAL HEALTH · arousal through withdrawal, anger, addiction, self-harm and suicidality, depression and anxiety, to name a few responses. It is not uncommon for First

Page 27 of 38

DIAGNOSTIC STATISTICAL MANUAL

The Diagnostic Statistical Manual (DSM) is a guide for medical and psychiatric practitioners that provides a

common language and standard criteria for the classification of mental disorders. It has both scientific and non-

scientific bases and is both praised and criticized.

SYMPTOMS, DURATION, AND PRESENTATION Mental health problems may present as a clinical mental illness or disorder as described in the DSM which

describes specific symptoms or characteristics over time, often more than 6 months.

Alternatively, mental health problems may present as subclinical without all the necessary characteristics and

without the intensity or duration described in the DSM that, nevertheless, affect a person’s thinking, feelings, or

behaviour negatively and cause distress and challenges to mental well-being and functioning.

Symptoms tend to cluster. When symptoms are clustered together for a determined length of time a diagnosis can

be made. In addition to a diagnosis, other factors are considered, such as: medical; psychosocial and environmental;

and personality.

Medical factors may be factors for consideration when treating mental illnesses, such as diabetes; chronic and

persistent pain; and cancer.

Page 29: FIRST NATION MENTAL HEALTH · arousal through withdrawal, anger, addiction, self-harm and suicidality, depression and anxiety, to name a few responses. It is not uncommon for First

Page 28 of 38

CLINICAL DISORDERS

ADDICTION AND MENTAL ILLNESS The concurrence of depression or anxiety with substance

abuse is common.

WHAT TO DO?

It is necessary to treat both at the same time

with a primary, but not exclusive, focus on the

one causing the most problems for the client

Match your intervention with the stage of change

they are in. Motivational Interviewing (MI) is a

method of support and intervention that

recognizes that at any point in time people are in different stages of change. Effective support and

interventions are matched with the client’s stage of change. Clients may be mislabeled as ‘resistant’ when

it is really the intervention does not match the client’s stage of change.

Matching Stages of Change with Interventions

PRE-CONTEMPLATIVE

Description: Other people say they have an addiction but the person reports that they do not have a problem.

Screening question: You say you don’t have a substance abuse problem; does anyone else think you have a

problem?

Interventions:

Build trusting relationships

Reduce harm to self & others, such as harm reduction strategies (i.e.: nutrition, adequate clothing, and

needle exchange)

Provide general health information

Support family

Provide general public, community messaging about the negative effects of substance abuse and the

cost of it going untreated for the individual, their family, and their community

Have fun, safe, substance-free community events

CONTEMPLATION Description: People think they may have an addiction problem but they are not totally convinced.

Screening questions: Is there part of you who does and part of you who does not see this as a problem?

Interventions:

Invite self-reflection

Recognize their ambivalence: On one hand you say this and on the other hand that.

Suggest they may not be ready for change quite yet

Ask: What would the reasons be to change?

Ask “How will you know when you are ready for change?”

Addiction and Mental Health

Information sheet:

Matching Stages of Change with Interventions

Page 30: FIRST NATION MENTAL HEALTH · arousal through withdrawal, anger, addiction, self-harm and suicidality, depression and anxiety, to name a few responses. It is not uncommon for First

Page 29 of 38

PREPARATION FOR CHANGE Description: People say that they need to change but changes have not begun yet.

Screening questions: What changes have you begun to think about?

Interventions:

Invite the person to begin to set personal goals with respect to social support, health, & recreation

Support without pressure; the time for cheerleading is later

Ask “When you are ready for change, what do you want to do?”

Support changes such as: delaying, changing context, switching time of day, & trying new social activities

CHANGE Description: People ready to change are changing one thing at a time in their life.

Screening questions: Have you tried to do anything differently this week?

Interventions:

Establish clear, attainable and measureable goals

Set up check-ins, follow-up with support network

Continue to address safety and other psychosocial, mental health, and medical concerns.

Be supportive without being too enthusiastic

RELAPSE PREPARATION AND STRATEGIES TO KEEP GOING Description: People are changing and are often deny any possibility of relapse.

Screening question: How are things changing for you?

Interventions:

Support, support, support - be a supportive cheerleader with encouragement and morale boosting

Tell them you have a no blame and no shame policy

Plan for crisis support

Develop alternatives to substance use

Plan for follow up together upon relapse

MAINTENANCE Description: People stabilize into a new lifestyle with changes; relapses are infrequent, short lived, or non-existent.

Interventions:

Celebrate with recognition privately or publicly

Review, in detail, the changes made

Update personal goals

Adapted from literature and training on Motivational Interviewing

Page 31: FIRST NATION MENTAL HEALTH · arousal through withdrawal, anger, addiction, self-harm and suicidality, depression and anxiety, to name a few responses. It is not uncommon for First

Page 30 of 38

DEPRESSION Screening for depression includes observing:

Changes in mood

Changes in eating and/or sleeping

Decreases in energy and interests

Thoughts or plans not to live

WHAT TO DO?

Make a referral to a mental health or medical practitioner

Consult immediately with the RCMP and/ or mental health or medical practitioners if there are concerns

of harm to self or others

Share the following: “You may be aware that if we challenge our beliefs and conclusions (our thinking and

emotions) we can change our behaviour. It works the other way, also. Change our behaviour and our

thinking and emotions change. Encourage person to keep going. Go for a walk. A change in our behaviour

can change our thinking which can change the way we feel.” www.yukonwellness.ca

Discuss perspective and how personal it is: Using the theatre scenario: woman gets up and angrily and

loudly leaves the man she is with…various perspectives from the audience

As mentioned, we can change our behaviour by challenging and reflecting on our thoughts and feelings.

www.yukonwellness.ca Invite people to be reflective on self rather than focus on others.

Practice mindfulness – in which we mind the mind or increase our awareness of what we are thinking &

feeling. Our thoughts and beliefs influence how we feel, which leads to healthy and sometimes unhealthy

behaviours.

Increase their ability to tolerate distress by brainstorming self-care options, alternative ways of looking at

what is distressing, time out options

Teach thought substitution, thought stopping, and visualization techniques for changing one’s own

experience

Encourage someone who is depressed to turn to their own spiritual beliefs for comfort and healing; such

as prayer, meditation, smudging, and other spiritual healing practices familiar to the person

Page 32: FIRST NATION MENTAL HEALTH · arousal through withdrawal, anger, addiction, self-harm and suicidality, depression and anxiety, to name a few responses. It is not uncommon for First

Page 31 of 38

ANXIETY Screening for anxiety includes observing:

Intense anxiety

Bodily experiences of anxiety

Recurring thoughts

Compelling behaviours

Avoidance of situations

WHAT TO DO?

Refer to a medical or mental health practitioner when your screening indicates the presence of anxiety

Support anxiety management techniques, including: breathing exercises, progressive deep muscle

relaxation, mindfulness, and talking to someone you trust

Lifestyle activities that promote mental health, such as physical activity and good nutrition

Cognitive and behavioural strategies that change the mind, such as:

Invite alternative ways to look at things in order to avoid thinking in terms of black and white; this or

that; with no in-between options

To illustrate how perspective varies from one person to the next: there are no absolutes; share the

example of a woman getting up in a theatre and angrily and loudly leaving the man she is with.

Discuss the various and possible perspectives from the audience, even with so little information: a

woman may feel proud of the woman or afraid as she remembers the times she has not been

assertive herself in challenging situations with her x-boyfriend; a man may reflect on his own past

social humiliations and feel sad for the man; a teenager feels anxious about beginning dating if that

is what could happen.

Increase reflections and awareness of thoughts and feelings

Increase their ability to tolerate distress by brainstorming self-care options, alternative ways of

looking at situations

Teach thought substitution, thought stopping, and visualization techniques for changing one’s own

experience

Encourage someone who is depressed to follow their own spiritual beliefs for comfort and healing; such

as prayer, meditation, smudging, and other spiritual healing practices familiar to the person

Page 33: FIRST NATION MENTAL HEALTH · arousal through withdrawal, anger, addiction, self-harm and suicidality, depression and anxiety, to name a few responses. It is not uncommon for First

Page 32 of 38

PSYCHOSIS Psychosis is a condition that affects the mind in terms of

the person’s ability to determine what is real and what is

not real characterized by:

Confused Thinking

Changed Feelings

Different Experiences – hallucinations

Faulty Beliefs – delusions

Symptoms by phase

Prodromal Phase includes changes in thoughts

and behaviours but no active psychosis

Acute Phase includes symptoms of psychosis

Recovery Phase includes medical treatment and

re-establishing daily activities and healthy relationships

From: Reality Rules brochure

WHAT TO DO?

Refer to the Health Centre, Mental Health Services, or Physician

Consult and collaborate with the Medical Team

Provide person with practical support regarding basic needs, such as: food and housing

Support families

Ensure safety of client, self and others

PSYCHOSIS

***

Information brochure: Reality Rules!

Page 34: FIRST NATION MENTAL HEALTH · arousal through withdrawal, anger, addiction, self-harm and suicidality, depression and anxiety, to name a few responses. It is not uncommon for First

Page 33 of 38

PERSONALITY DISORDERS

Personality disorders have three shared characteristics:

Difficulty in relationships

Inflexible thinking

Blame outside factors for their own experience

The following selected personality traits and disorders may create challenges to health and social workers with

respect to support, interventions, and community response.

DEPENDENT PERSONALITY TRAITS & DISORDER The tendency toward dependency includes a felt need to be taken care of that leads to submissive and clinging

behaviour and fears of separation, beginning by early adulthood and present in a variety of contexts with 5 or

more of the following signs and symptoms:

Dependent on others for emotional and physical support

View others as strong and capable

Inadequate and helpless self-image

Afraid of being unable to look after themselves

As caregivers we can be convinced we are helping when really encouraging dependence. People with dependent

personalities can be very accommodating, agreeable, but seek attention and advice excessively.

WHAT TO DO?

Establish clear boundaries

Establish safe and secure routines for providing assistance.

Seek regular supervision

Seek consultation from a mental health clinician or medical practitioner

Ensure worker self-care

Manage crises with the minimum of support needed

Encourage competence

Page 35: FIRST NATION MENTAL HEALTH · arousal through withdrawal, anger, addiction, self-harm and suicidality, depression and anxiety, to name a few responses. It is not uncommon for First

Page 34 of 38

BORDERLINE PERSONALITY TRAITS/DISORDER Persons with BPD have patterns of instability in their interpersonal relationships, self-image, emotions; and

marked impulsivity beginning in early adulthood and present in a variety of contexts with five or more of the

following signs and symptoms:

Emotionally unstable

Issues of self-image and identity

Black and white thinking that can switch around quickly

Harm to self

WHAT TO DO?

Educate team members and colleagues about the need for effective team communication and

collaboration. Be prepared for, and even predict, rejection/anger/ and notice when groups of helpers are

in intense disagreement. When a community of caregivers and family members are conflicted and

divided in the care of a client/family member, the possibility of the client having BPD must be considered.

Dualistic thinking (black and white and either/or thinking) may set one caregiver against another as they

align and support the client who fluctuates in there interpersonal relationships from idealization of some

caregivers and devaluation of others. Good guy/bad guy agreements may work to diffuse potentially

unsafe and volatile interpersonal situations.

Refer the person with BPD to Mental Health Services

The best practices for treating someone with BPD is developing skills that focus on:

Increasing distress tolerance

Regulating emotions

Building interpersonal effectiveness

Mindfulness meditation

Finding alternative

Treat the person with BPD as competent with rationale and decision-making qualities upon which they

can build

Seek supervision or mental health consultation that supports your own awareness of the dynamics of the

illness and self-management techniques of caregivers

Page 36: FIRST NATION MENTAL HEALTH · arousal through withdrawal, anger, addiction, self-harm and suicidality, depression and anxiety, to name a few responses. It is not uncommon for First

Page 35 of 38

NARCISSISTIC PERSONALITY TRAITS/DISORDER A person with narcissistic traits demonstrates a pattern of grandiosity in fantasy or behaviour, need for admiration,

and lack of empathy, beginning by early adulthood and present in a variety of contexts and includes the:

Excessive need for attention and control

Strong reactions to criticism

WHAT TO DO?

Find out what is important to them and what they will gain from behaving differently

Seek mental health or medical consultation particularly when there are safety concerns.

Seek support from a mental health clinician or medical practitioner for a consultation that supports your own knowledge of the dynamics of the disorder and self-management techniques for caregivers

Page 37: FIRST NATION MENTAL HEALTH · arousal through withdrawal, anger, addiction, self-harm and suicidality, depression and anxiety, to name a few responses. It is not uncommon for First

Page 36 of 38

SUMMARY This First Nation Mental Health: Curriculum on Mental Wellness and Mental Illness provides information,

consultation, recommendations for practice, and skill development for First Nation health and social service

workers for their benefit and for the benefit of the individuals, families, and communities with whom they work.

During its development, the curriculum was offered to Yukon First Nations over a 6 month period. The workshops

yielded valuable information and focused feedback from participants. Most notably, the wellness information was

well received. In particular, practical information around nutrition and the concepts of positive psychology were

systematically introduced and welcomed by participants, being consistent with their preference for strength-based

approaches Also noteworthy, not a single teleconference or face-to-face workshop went by without discussions

and case consultations related to the concurrence of addictions and mental illness, and the concurrence of mental

health challenges and ongoing historic and current safety concerns. Participants sought consultation regarding

how to understand and how to respond effectively with clients and communities regarding addictions and past

traumas. The role of safety in mental health is consistent with the literature on the social determinants of health

and reminiscent of Maslow’s Hierarchy of Needs in which physiological and safety needs are foundational to

health.

Supplementary resources were created in response to feedback from participants to fill gaps in knowledge and to

make materials available for health and social service workers as reminders and to share with people in their

communities.

Participants and the facilitator report that there was generally adequate breadth of coverage on the topics,

consultations, and suggested interventions. On-going or more depth is recommended in the future regarding:

Addiction and mental illness; and related interventions

Training in effective interventions that address violence, particularly but not limited to: violence against

women and Elders resulting in unhealthy lifestyles and poor mental health

On-going case consultation for health and social service workers regarding mental wellness and mental

illness

Further development on the the Meaning and Accomplishment components of Seligman’s Flourish for

greater meaning and applicaton in the First Nation context

The curriculum is designed for delivery in part or in whole; and more can be added, such as the inclusion of

additional mental disorders and recommended interventions.

Page 38: FIRST NATION MENTAL HEALTH · arousal through withdrawal, anger, addiction, self-harm and suicidality, depression and anxiety, to name a few responses. It is not uncommon for First

Page 37 of 38

BIBLIOGRAPHY 10 Facts on Mental Health. n.d.

<http://www.who.int/features/factfiles/mental_health/mental_health_facts/en/index9.html>.

Adult Health - Forgiveness: Letting Go of Grudges and Bitterness. n.d.

<http://www.mayoclinic.com/health/forgiveness/MH00131>.

Brymer, M. Psychosocial First Aid: Field Operations Guide 2nd Edition. 2006.

Canadian Nurses' Association. n.d.

<http://www.nurseone.ca/Default.aspx?portlet=StaticHtmlViewerPortlet&plang=1&ptdi=1764 >>.

Combating the Winter Blues. 2009.

<http://www.msoe.edu/life_at_msoe/current_student_resources/student_resources/counseling_service

s/newsletters_for_mental_health/combating_the_winter_blues.shtml>.

Conflict Resolution Skills. n.d. <http://www.helpguide.org/mental/eq8_conflict_resolution.htm>.

Coping with Grief and Loss. n.d. <http://www.helpguide.org/mental/grief_loss.htm>.

Cultural Safety. n.d. <http://en.wikipedia.org/wiki/Cultural_safety>.

Durson, Serdar M. "Vitamin D for Mental Health and Cognition." Canadian Medical Association Journal (2010).

<http://www.cmaj.ca/content/182/17/1886.2.full>.

Eating Well. n.d. <http://www.rcpsych.ac.uk/expertadvice/problems/eatingwellandmentalhealth.aspx>.

Five Ways to Wellbeing. n.d. <http://www.yukonwellness.ca/fiveways.php#.UTuJYdaR-E4>.

Fredrickson, Barbara L. Positivity. New York: Random House, 2009. <http://www.positivityratio.com/index.php>.

Fredrickson, Barbara. Positivity Ratio. n.d. <http://www.positivityratio.com/single.php>.

Get Out of Depression. n.d. <http://getoutofdepression.wordpress.com/tag/mental-health/>.

Grieving. n.d. <http://www.cmha.ca/mental_health/grieving/#.UTwObtaR-E5>.

Health Impact Assessment: The Determinants of Health. n.d. <http://www.who.int/hia/evidence/doh/en/ >.

Kendall-Tackett, K. Long-chain Omega-3 fatty acids and Women's Mental Health in the Pernatal Period and

Beyond. 2005. <http://www.ncbi.nlm.nih.gov/pubmed/20974418 >.

Kirby, MIchael J.L., Wilber Joseph Keon. "Out of the Shadows." Yukon First Nations' Mental Wellness Workbook

May 2006.

Laframboise, Sandra, Karen Sherbina. Dancing to Eagles Spirit Society. n.d.

<http://www.dancingtoeaglespiritsociety.org/medwheel.php>.

Liard Aboriginal Women's Society, Royal Canadian Mounted Police. "Together for Justice Safety Protocol." Watson

Lake, Yukon, Signed March 5, 2013.

Mental Health. n.d. <http://www.who.int/features/factfiles/mental_health/en/>.

Page 39: FIRST NATION MENTAL HEALTH · arousal through withdrawal, anger, addiction, self-harm and suicidality, depression and anxiety, to name a few responses. It is not uncommon for First

Page 38 of 38

Mental Health and 'Lifestyle'. n.d. <http://www.yukonwellness.ca/mentalhealth.php#.UTuMmNaR-E4>.

Mihaly Csikszentmihalyi: Flow: the secret of happiness. n.d.

<http://www.ted.com/talks/mihaly_csikszentmihalyi_on_flow.html>.

Mokkonen, Juha, Dennis Raphael. Social Determinants of Health: The Canadian Facts. Toronto: York University

Health & Policy management, 2010. <http://www.thecanadianfacts.org/>.

Peet, M., C. Stokes. Omega-3 Fatty Acids in the Treatment of Psychiatric Disorders. 2005.

<http://www.ncbi.nlm.nih.gov/pubmed/15907142>.

Psychological Consequences of Vitamin D Deficiency. 2011. <http://www.psychologytoday.com/blog/the-

breakthrough-depression-solution/201111/psychological-consequences-vitamin-d-deficiency>.

Reina, Dennis, Michelle Reina. Rebuilding Trust in the Workplace. San Francisco: Berrett-Koehler Publishers, 2010.

<http://www.reinatrustbuilding.com/>.

Relationships Matter. n.d. <http://www.yukonwellness.ca/relationships.php#.UTuaI9aR-E4>.

Richardson, Catherine, Allan Wade. "Taking Resistance Seriously." Strega, Joanne, Jeannine Carriere. Walking This

Path Together. n.d.

Seasonal Affective Disorder Treatment. n.d. <http://www.mayoclinic.com/health/seasonal-affective-disorder-

treatment/DN00013>.

Seligman, Martin E.P. Flourish. New York: Free Press, 2011.

Sharma, Ashish, Vishal Maadan, Frederick D. Petty. "Exercise for Mental Health." Primary Companion Care Journal

of Clinical Psychiatry (2006). <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1470658/>.

The 3:1 Ratio. n.d. <http://www.yukonwellness.ca/3to1.php#.UTuHbNaR-E4>.

The Science of Mental Illness. n.d. <https://science.education.nih.gov/supplements/nih5/mental/guide/info-

mental-a.htm>.

Water is your friend. n.d. <http://getoutofdepression.wordpress.com/2013/01/31/water-is-your-friend/ >.

What Makes A Good Life? n.d. <http://umbrellahealth.wordpress.com/?s=accomplishment&submit=Search>.

What Makes You Happy? UTube Video. n.d. <http://www.youtube.com/watch?v=As-g_dwgJig>.

What You Need To Know About Vitamin D. n.d. <http://www.eatrightontario.ca/en/Articles/Nutrients-(vitamins-

and-minerals)/What-you-need-to-know-about-Vitamin-D.aspx>.


Recommended